Hospitals working together to reduce surgical complications

Connecticut hospitals traditionally considered competitors have been quietly teaming up to share techniques to reduce surgical infections and complications.

The idea is to improve patient care and efficiency in a landscape of skyrocketing health care costs and pressure from the federal Affordable Care Act to improve performance.

On Friday, surgeons, hospitals, health plan providers, physicians and politicians gathered at the state Capitol for a symposium to raise public awareness of hospitals’ efforts to contain costs and to discuss challenges that lie ahead in health care reform.

The Connecticut Surgical Quality Collaborative, a group of 20 acute-care hospitals, has been meeting monthly to share data openly, communicate and identify top-performing hospitals in certain areas of post-surgical infection.

After pinpointing the hospitals that are doing the best job reducing post-surgical infections and preventing other complications such as pneumonia and kidney failure, the group shares the most effective techniques to improve quality at all other hospitals.

“We’re putting aside the competitive nature you hear about out on the market and use collaboration and data so all patients have better outcomes,” said Scott J. Ellner, director of surgical quality at St. Francis Hospital and Medical Center and chairman of the collaborative.

Besides the most obvious benefit of healthier patients, the collaboration can also add up to big savings because infections can be costly. For example, the average cost of a urinary tract infection caused by leaving a catheter in too long after surgery is about $12,000, including a hospital stay, a CT scan, IVs and antibiotics, Ellner said.

And that’s not even a worst-case scenario. A serious urinary tract infection that requires treatment in an intensive care unit can cost $58,000, Ellner said.

The group pays the American College of Surgeons to provide improvement program guidelines and crunch the data from the participating hospitals. The ACS estimates that each participating hospital can eliminate 250 to 500 complications in a single year, saving an estimated $2.9 million to $5.8 million a year through the program.

Nationwide, if participation in the effort expands to 4,500 hospitals, potential savings over one year could total $13 billion to $26 billion, according to the ACS.

And health care reform has given hospitals an extra incentive to stay infection-free. Under Obamacare, Medicaid and commercial insurance will no longer reimburse for urinary tract infections, so hospitals must cover the cost themselves, Ellner said. By 2015, reimbursements for wound infections from colorectal surgery — which occur in 21 percent of such surgeries in Connecticut, Ellner said — will not be provided for under the Affordable Care Act. Ellner did not have an estimated cost for this type of complication.

During the symposium, sponsored by the American College of Surgeons, several speakers talked about the rising cost of health care and changes in hospital culture.

Kevin J. Counihan, CEO of Access Health CT, said premium rate increases are among the greatest threat to sustainable health care reform, and he welcomes innovation and competition to reduce costs. Access Health CT is an insurance marketplace developed by the state to satisfy requirements of the federal health care reform act.

“We have the fourth-highest insurance costs in the country,” Counihan said. “It really becomes a middle-class affordability issue.”
Others talked about the cultural transformation going on within some hospitals and health care in general to try to become more transparent to improve safety. Rocco Orlando III, senior vice president and chief medical officer at Hartford HealthCare, said it is critical for leaders to foster an atmosphere of openness to allow staff to feel comfortable enough to point out safety issues.

Andrew Baskin, the national medical director of quality and provider performance at Aetna Inc., suggested that health plan companies partner with provider groups, hospitals and others to improve care, share information and improve connectivity to doctors.

“I think there are things that we can do together to really enhance your ability to improve the quality of care provided,” Baskin said.